A realistic computer game will soon be used to help dental students worldwide learn and reinforce dental implant procedures.

The Virtual Dental Implant Training Simulation Program is designed to help students in diagnostics, decision making and treatment protocols. It was designed by Medical College of Georgia School of Dentistry faculty and students and BreakAway, Ltd., a developer of game-based technology for training, experimentation and decision-making analysis.

"There's a lot of enthusiasm in the global dental and medical communities to use virtual reality and simulation as a tool to convey and reinforce information and ensure competency levels," says Dr. Roman Cibirka, MCG vice president for instruction and enrollment management and the program's project director. He presented the game and its 18-month development process today at the fifth annual Games for Health Conference in Boston.

Dental implants are tiny screws surgically placed in the jaw to act as artificial roots for prosthetic teeth. About 25 percent of adults 60 and older no longer have any natural teeth, according to the Centers for Disease Control and Prevention, and the need for this procedure could increase with the country's aging population.

"The program was an opportunity to align the defined need to enhance the depth and penetration of implant therapy knowledge in undergraduate dental education with my vision of using gaming to reach the millennial student," Dr. Cibirka says.

His highest priorities were instructional effectiveness, patient safety and a fun learning environment for the students.

Research shows that health care providers who practice clinical skills via simulation have better patient outcomes than those who don't.

The implant simulation game uses multiple patients and clinical scenarios that can be randomly selected, letting students interact with virtul patients by asking about their medical history, examining them and arriving at a diagnosis. Like humans, the virtual patients have different personalities, and students must tailor treatment based on the mental, physical and emotional needs of the individual.

If the virtual patient is a candidate for implant therapy, the simulation then ventures into a virtual clinical treatment area, where students decide the type, location and orientation of the implants, type and location of anesthesia and tools for surgery.

"It's realistic. If the student doesn't place anesthesia in the right spot, the patient screams," Dr. Cibirka says.

The game uses Pulse!! Virtual Learning Lab, developed by BreakAway in partnership with Texas A&M University-Corpus Christi through funding from the Office of Naval Research.

As effective as the learning tool is, it is intended to supplement - not replace - actual clinical training.

"It's anytime, anywhere education; a classroom without walls," Dr. Cibirka says. "I think it really fortifies the entire educational experience and capitalizes on the needs of this generation."

Being overweight is a health concern, and using only body mass index (BMI) to determine weight classification may not give an accurate picture of a person's health, according to an advisory published in Circulation: Journal of the American Heart Association.

About one-third of the U.S. population is overweight - the middle range between normal weight and obesity. Overweight in adults is a BMI of 25.0 to 29.9. BMI is a numerical value of weight in relation to height.

Studies that examined the relationship between overweight (as measured by BMI) and risk of death from all causes (often referred to as total mortality) have had contradictory results. However, considering death from all causes overlooks the role that overweight may play in the development of risk factors for cardiovascular diseases.

Even among the young, overweight is related to the development of serious risk factors for cardiovascular disease, such as high blood pressure, obesity, elevated levels of cholesterol and type 2 diabetes.

Part of the problem with quantifying the true impact of overweight lies in the way it's commonly measured, say the experts. The widely-used body mass index doesn't distinguish between fat mass which is related to important health concerns - such as type 2 diabetes - and lean mass, including muscle, which reduces health risks. Also, BMI does not directly measure the distribution of fat, such as whether there is greater fat at the waist than at the hips, which may be more detrimental to health.

Focusing on the relationship between total mortality and BMI misses the "larger picture," the statement said.

"This larger picture includes important relationships between BMI and other health outcomes, such as cardiovascular disease and its risk factors," said Cora E. Lewis, M.D., M.S.P.H., lead author of the advisory and professor of medicine and public health at the University of Alabama at Birmingham. "Arguably, the most important relationship among the cardiovascular disease risk factors is diabetes, which is significantly more common in overweight than in normal-weight people."

The advisory recommends doing research on overweight and health, beyond studies that focus solely on the relationship between total body mass index and risk of death.

"Meanwhile, we cannot afford to wait for this research to begin addressing the problem of overweight in our patients and in our society," write the advisory authors.

An increasing number of children are overweight, which puts them at risk for developing higher than normal blood pressure, blood cholesterol and blood sugar.

"Weight gain is progressive and weight loss difficult. Although a young child is unlikely to have a heart attack, overweight children are likely to become overweight or obese adults, which puts them at risk for cardiovascular events as they mature. Achieving and maintaining a healthy body weight is of high importance for all Americans," said Lewis.

Physical inactivity and excess weight increase risk of death and other adverse health outcomes; so overweight and obese persons in particular would benefit from adopting a physically active lifestyle and healthy eating habits.

Grabbing a quick nap may not only be refreshing but may also increase your ability to solve problems creatively, according to US researchers who suggest that REM (rapid eye movement) sleep directly enhances creative processes more than any other sleep or wakeful state.


The researchers said their findings are important because they show that sleep, and REM sleep in particular, helps the brain to form "associative networks".

Mednick said:

"For creative problems that you've already been working on -- the passage of time is enough to find solutions."

"However," she added, "for new problems, only REM sleep enhances creativity."

The researchers discovered that it looks as if REM sleep stimulates associative networks helping the brain to make new and useful connections between unrelated ideas, the key to creativity.

Previous studies have shown that sleep enhances problem solving, but they have not properly explored the effect of types of sleep, such as that with and without REM.

Also scientists don't really know whether creative thinking improves after sleep because of the effect of the sleep itself or because going to sleep removes distractions and interference that can disrupt the consolidation of memory; so this study included a comparison group that did not sleep but just had quiet rest.

Mednick and colleagues used a creativity task called Remote Associates Test (RAT) where participants were shown groups of three words (for example "cookie", "heart", "sixteen") and asked to find a fourth word that linked them all together (eg the word "sweet" in the example).

The participants did the test in the morning and then again in the afternoon after they had either had a nap with REM sleep, a nap without REM sleep, or spent some quiet time resting with no verbal inputs.

The results showed that the three groups performed the same on memory tests, but although the quiet rest and non-REM nap group had the same exposure to the task, their performance on the RAT test was the same in the morning and the afternoon.

But what was striking was that the nap with REM group improved their performance by 40 per cent in the afternoon compared to the morning.

"Compared with quiet rest and non-REM sleep, REM enhanced the formation of associative networks and the integration of unassociated information," wrote the authors.

They suggested that REM sleep causes changes in the levels of neurotransmitters, or more specifically "changes in cholinergic and noradrenergic neuromodulation" in the brain and this makes new linkages between previously unlinked networks which enhances "the integration of unassociated information for creative problem solving".

Indian scientists said on Saturday they had cloned the world’s second buffalo just three months after the first one died of pneumonia within a week of birth.

The calf, named Garima, was born at 11 a.m. at the National Dairy Research Institute (NDRI), Karnal, and weighed 43 kg, Institute Director A.K. Srivastava told PTI.
Precautionary measure

“Garima is healthy, and we are optimistic about her survival. Two veterinarians have arrived from the Haryana Agricultural University. Our own veterinary doctors, led by K.P.S. Tomar, are also looking after her, and we are taking precautions to avoid any mishap,” Mr. Srivastava said.

Scientists adopted a technique more advanced than the one used in producing Dolly, the sheep that became the first mammal to be cloned. The ‘hand-guided cloning technique,’ perfected by NDRI scientists, would allow production of calves of a desired sex.

However, the scientists have used the foetal tissue to clone the calf this time instead of the ear tissue of a female buffalo, as they did last time.

The first cloned buffalo was born on February 6.

India, Mr. Srivastava said, had the largest population of the best buffaloes in the world. However, the percentage of elite animals was very low, and there was a need to enhance their population. The cloning technique would help address this problem. — PTI

The world's largest ear, nose, and throat professional medical association, the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS), has released a manual detailing best practices for the creation of new clinical practice guidelines. The manual is published as a supplement to the June issue of Otolaryngology - Head and Neck Surgery.

Clinical practice guidelines are created to help direct decisions and criteria regarding diagnosis, management, and treatment in medical practice. They seek to identify, summarize, and evaluate the best evidence and most current data about prevention, diagnosis, prognosis, therapy (medication/procedures), risk vs. benefit profile, and cost-effectiveness.

"Clinical practice guidelines translate best evidence into best practice. A well-crafted guideline promotes quality by reducing healthcare variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective - or potentially harmful - interventions," said Richard M. Rosenfeld, MD, MPH, co-author of the guideline. "Despite a plethora of published guidelines, methodology is often poorly defined and varies greatly within and among organizations."

According to the authors, published guidelines are often poorly suited to assess performance or influence care, because recommendations do not translate into measurable actions or activities. Moreover, the development process is generally inefficient and highly complex, requiring, on average, about two to three years per guideline. Using the process outlined in the new manual, the AAO-HNS was able to publish five multidisciplinary guidelines in five years, all within 12 months from conception to completion.

The goals of publishing the manual were, first, to provide clinicians with a straightforward explanation of guidelines, considering their increasing prominence as a quality metric. Secondly, the manual is intended to be a pragmatic resource, accurately reflecting current practices, in order to sustain consistency across guideline development practices. Finally, the manual seeks to share the AAO-HNS' successful development process with the medical community at large, to encourage an exchange of ideas and to promote best practices.

"Our goal was to create an approach to guideline development that is both practical and transparent. Guideline users increasingly recognize that understanding the evidence supporting a recommendation is vital, but that authoring teams must additionally weigh and document anticipated benefits, risks, harms, and costs," said Richard N. Shiffman, MD, MCIS, co-author of the manual.

The manual breaks down the development process and gives in-depth instructions for guideline task force administrators. The steps include planning, literature review, assigning the writing, peer review, organizational board review, and publication.

As clinical practice guidelines become more prominent as key metrics of quality healthcare, organizations must develop efficient production strategies that balance rigor and pragmatism. Equally important, clinicians must become savvy in understanding what guidelines are - and are not - and how they are best utilized to improve care. The information in this manual should help clinicians and organizations achieve these goals, and improve patient care.